The two main types of smokeless tobacco in the United States are chewing tobacco and snuff.1,2 Chewing tobacco comes in the form of loose leaf, plug, or twist.1,2 Snuff is finely ground tobacco that can be dry, moist, or in sachets (tea bag-like pouches).2 Although some forms of snuff can be used by sniffing or inhaling into the nose,2 most smokeless tobacco users place the product in their cheek or between their gum and cheek.3 Users then suck on the tobacco and spit out the tobacco juices, which is why smokeless tobacco is often referred to as spit or spitting tobacco.3 Smokeless tobacco is a significant health risk and is not a safe substitute for smoking cigarettes.4

Health Effects

Smokeless tobacco contains 28 cancer-causing agents (carcinogens).2 It is a known cause of human cancer,5 as it increases the risk of developing cancer of the oral cavity.5 Oral health problems strongly associated with smokeless tobacco use are leukoplakia (a lesion of the soft tissue that consists of a white patch or plaque that cannot be scraped off) and recession of the gums.3

Smokeless tobacco use can lead to nicotine addiction and dependence.4

Adolescents who use smokeless tobacco are more likely to become cigarette smokers.3

High-Risk Populations and Current Estimates

Smokeless tobacco use in the United States is higher among young white males; American Indians/Alaska Natives; people living in southern and north central states; and people who are employed in blue collar occupations, service/laborer jobs, or who are unemployed.6

Nationally, an estimated 3% of adults are current smokeless tobacco users.7 Smokeless tobacco use is much higher among men (6%) than women (0.4%).7

In the United States, 9% of American Indian/Alaska Natives, 4% of whites, 2% of African Americans, 1% of Hispanics, and 0.6% of Asian-American adults are current smokeless tobacco users.7

An estimated 8% of high school students are current smokeless tobacco users.8 Smokeless tobacco is more common among males (13.6%) than female high school students (2.2%).8 Estimates by race/ethnicity are 10.2% for white, 5.1% for Hispanic, and 1.7% for African-American high school students.8

An estimated 3% of middle school students are current smokeless tobacco users.9 Smokeless tobacco is more common among male (4%) than female (2%) middle school students.9 Estimates by race/ethnicity are 3% for white, 1% for Asian, 2% for African-American, and 4% for Hispanic middle school students.9

Other Information

During 2005, the five largest tobacco manufacturers spent a new record of $250.79 million on smokeless tobacco advertising and promotion, versus the previous record of $236.68 million in 2001.1

The two leading smokeless tobacco brands for users aged 12 years or older are Skoal (28%) and Copenhagen (22%).10

National Cancer Institute. Smokeless Tobacco or Health: An International Perspective. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 1992. Available from: http://cancercontrol.cancer.gov/tcrb/monographs/2/index.html. Accessed: December 2006.

U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_1994/index.htm. Accessed: December 2006.

U.S. Department of Health and Human Services. The Health Consequences of Using Smokeless Tobacco: A Report of the Advisory Committee to the Surgeon General, 1986. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service. NIH Pub. No. 86-2874. Available from: http://profiles.nlm.nih.gov/NN/B/B/F/C/. Accessed: December 2006.

U.S. Department of Health and Human Services. Reducing the Health Consequences of Smoking—25 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, CDC; 1989. DHHS Pub. No. (CDC) 89–8411. Available from: http://profiles.nlm.nih.gov/NN/B/B/X/S/. Accessed: December 2006.

Centers for Disease Control and Prevention. Tobacco Use, Access, and Exposure To Tobacco in Media Among Middle and High School Students–United States, 2004. MMWR 2005;54(12):297-301. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5412a1.htm. Accessed: December 2006.
Substance Abuse and Mental Health Services Administration. Results From the 2005 National Survey on Drug Use and Health: Detailed Tables. (PDF–111KB) Rockville, MD: